Staging a performance: learners’ perceptions about direct observation during residency
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
CONTEXT: Evidence strongly supports that direct observation is a valid and reliable assessment tool; support for its impact on learning is less compelling, and we know that some learners are ambivalent about being observed. However, learners' perceptions about the impact of direct observation on their learning and professional development remain underexplored. To promote learning, we need to understand what makes direct observation valuable for learners. METHODS: Informed by constructivist grounded theory, we interviewed 22 learners about their observation experiences. Data collection and analysis occurred iteratively; themes were identified using constant comparative analysis. RESULTS: Direct observation was widely endorsed as an important educational strategy, albeit one that created significant anxiety. Opaque expectations exacerbated participants' discomfort, and participants described that being observed felt like being assessed. Consequently, participants exchanged their 'usual' practice for a 'textbook' approach; alterations to performance generated uncertainty about their role, and raised questions about whether observers saw an authentic portrayal of their knowledge and skill. CONCLUSION: An 'observer effect' may partly explain learners' ambivalence about direct observation; being observed seemed to magnify learners' role ambiguity, intensify their tensions around professional development and raise questions about the credibility of feedback. In turn, an observer effect may impact learners' receptivity to feedback and may explain, in part, learners' perceptions that useful feedback is scant. For direct observation to be valuable, educators must be explicit about expectations, and they must be aware that how learners perform in the presence of an observer may not reflect what they do as independent practitioners. To nurture learners' professional development, educators must create a culture of observation-based coaching that is divorced from assessment and is tailored to developing learners' identities as practitioners of both the art and the science of medicine.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it